Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To investigate the genesis of the third ( IIIs ) and fourth heart sounds (IVs), apical phonocardiograms were recorded simultaneously with pulsed Doppler signals of the mitral flow and interventricular septal (IVS) and left ventricular posterior wall (PW) echoes by M-mode echocardiography in 26 cases with the IIIs and 11 cases with the IVs. The following results were obtained: Cases with the IIIs were classified into the following three groups according to the time relationship between the IIIs and a rapid filling wave (D wave) of the mitral flow velocity pattern. IIIs -peak group: The IIIs occurred coincidently with the peak of the D wave in five healthy adolescents and in 12 cases with absolute left ventricular volume overload including mitral regurgitation (MR: eight cases), postoperative atrial septal defect (ASD: three cases) and ventricular septal defect (one case). IIIs -delay group: The IIIs occurred about 38 msec after the peak of the D wave in eight cases with relative left ventricular volume overload including congestive cardiomyopathy (CCM: three cases) and ischemic heart disease (IHD: five cases). IIIs -early phase group: The IIIs occurred about 35 msec before the peak of the D wave in a case with acute MR due to chordal rupture. In the IIIs -peak group, the IIIs coincided in time with the points of inflection (check points) of both the IVS and PW during rapid filling phase in three cases with MR of mild to moderate degree and one case of postoperative ASD. In the IIIs -delay group, the IIIs occurred simultaneously with either the check point of the IVS or PW in two cases with CCM and one case with IHD, and it occurred before the check points of both the IVS and PW in two cases with severe MR of IIIs -peak group and in a case with acute MR due to chordal rupture of IIIs -early phase group. Cases with the IVs were classified into following 2 groups according to the time relationship between the IVs and the atrial contraction wave (A wave) of the mitral flow velocity pattern. IVs-peak group: The IVs occurred coincidentally with the peak of the A wave in six cases with left ventricular hypertrophy including hypertrophic cardiomyopathy (five cases) and hypertension (one case). IVs-delay group: The IVs occurred about 33 msec after the peak of the A wave in five cases with left ventricular dilatation or dysfunction including old myocardial infarction (two cases), CCM (one case), postoperative ASD (one case) and aortic regurgitation (one case). There were two types of IVs in time relationship between the IVs and the check points of the left ventricular wall during atrial contraction phase.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Studies on the mechanisms of the third and fourth heart sounds: with special reference to the phase analysis of mitral flow velocity pattern]. 667 90

Among 280 infants under 1 year of age with congenital heart disease autopsied at the University of Colorado Health Sciences Center between 1959 and 1978, there were six instances of grade IV1 pulmonary artery hypertension. Five were patients with ventricular septal defect (four associated with other cardiovascular malformations). The sixth was a patient with atrioventricular canal. The youngest was 2 1/2 months of age. Advanced degrees of pulmonary hypertensive arteriopathy (grade IV or more) have been said to be rare in infants, especially under the age of 1 year. The fact that all of these cases occurred within the last few years of the study suggests the possibility of improved supportive care leading to the prolonged survival of infants who might otherwise have died prior to developing severe disease. In addition, the role of altitude in accelerating the arteriopathy must be considered in the present series. In any case, this unexpected increase in the frequency of severe pulmonary hypertensive arteriopathy should stimulate consideration of early surgical correction of the underlying cardiovascular malformation, especially in areas of relatively high altitude.
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PMID:Pulmonary hypertension in congenital heart disease: irreversible vascular changes in young infants. 668 92

Insertion of extracardiac right ventricular (RV)-pulmonary artery (PA) conduits for repair of severe forms of RV-PA discontinuity has become a widely used technique. During a 10-year period, 76 patients had open heart repair with a porcine-valved RV-PA external conduit. The most common diagnoses were truncus arteriosus (15%) and pulmonary atresia with ventricular septal defect (15%). The patients were 18 days to 37 years old (median 7 years). The postoperative median follow-up period was 4 years. Four patients (8%) have been lost to follow-up. Nineteen patients (25%) died in the early postoperative period and there were 10 late deaths (13%). Calculated probability of survival was 66% at 8 years. Thirty-six patients have undergone late hemodynamic studies. A residual shunt was present in 14% of the patients; moderate to severe PA hypertension was present in 25% and significant RV-PA gradients (greater than 30 mm Hg) in 50%. The mean RV pressure for the group was 78.5 +/- 38 mm Hg. The severity of the gradients appeared to be greater in patients who had been followed longer. Ten patients have undergone reoperation because of conduit obstruction or residual shunting; 6 are alive and well. Of the surviving patients, 95% are acyanotic and without significant exercise intolerance and only 5% have cardiovascular symptoms. Thus, open heart repair using an external RV-PA conduit provides a marked improvement in the quality of life in patients who survive.
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PMID:Postoperative assessment of porcine-valved right ventricular-pulmonary artery conduits. 669 Dec 63

Indexes of right ventricular (RV) systolic function were evaluated in 41 patients undergoing cardiac catheterization. High-fidelity tracings were used to determine RV pressure, maximal RV dP/dt and the velocity of contractile element shortening at a developed pressure of 10 mm Hg (VCE10). In 14 children with an RV systolic pressure less than 35 mm Hg, normal RV volume, pulmonary vascular resistance (PVR) less than 3 units X m2 and no shunts (our normal group), mean (+/- standard deviation) RV dP/dt was 437 +/- 116 mm Hg X s-1 and VCE10 was 1.15 +/- 0.33 muscle length X s-1. In patients with RV systolic hypertension due to valvular pulmonary stenosis or isolated increases in PVR, mean values for RV dP/dt and VCE10 were significantly (p less than 0.05) greater than the normal values. In patients with a ventricular septal defect, RV hypertension and normal PVR, VCE10 was normal but RV dP/dt was significantly elevated. Children with chronic RV volume overload had normal RV contractile indexes. No patient in any group had values for RV dP/dt or VCE10 that were less than normal (mean normal - 2 standard deviations). This study establishes for the first time the indexes of RV isovolumic systole in children. It also shows that RV contractile function is preserved in young patients with chronic RV pressure or volume overload who do not have overt congestive heart failure.
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PMID:Right ventricular contractile function in children with congenital heart disease. 670 44

Between January 1973 and July 1981, 128 patients less than 1 year of age with failure to thrive, congestive heart failure or pulmonary artery hypertension underwent primary repair of a ventricular septal defect. The hospital mortality rate was 7.8% (10 of 128), and the late mortality rate was 2.3% (3 of 128). Mortality was highest among younger infants with preexisting respiratory problems or a hemodynamically significant residual lesion postoperatively. Complications included a large residual shunt in eight (6.2%), transient neurologic problems in five (3.9%) and persistent complete heart block in three (2.3%). Lung biopsy specimens obtained from 49 patients showed pulmonary vascular abnormalities in all. Complete right bundle branch block developed in 74 (64%) and bifascicular block appeared in 11 (9%). Recatheterization in 70 patients (55%) showed normal pulmonary artery pressures in all but 2 patients with a large residual shunt. Complete closure of the defect had been achieved in 49 (70%), and a hemodynamically insignificant shunt remained in 19 (27%). Patients without significant hemodynamic residua were asymptomatic and tended to accelerate in growth after surgery.
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PMID:Primary surgical closure of ventricular septal defect in the first year of life: results in 128 infants. 670 79

The role of active and passive factors involved in the genesis of Pulmonary Arterial Hypertension (PAH) is analyzed in a group of eighty patients with several cardiopathies and pneumopathies. The group include: 20 patients with Chronic Obstructive Lung Disease (NODC), 20 with Diffuse intersticial pneumopathy (NI), 12 with Cardiorespiratory Syndrome of the grossly obese (OB), 6 with Pulmonary Embolism (TEP), 6 with Mitral Stenosis (CRI), 5 with Hypertensive Ventricular Septal Defect (CIV + HAP) and 11 patients with Pulmonary Arterial Hypertension of Unknown etiology (HAP-ED). For the analysis, the Harvey and Enson's formulas were used. The conclusions of the study are: 1) The compliance of the elastic arteries of the lung in the groups of NOC, NI and OB is normal but in the other groups seems to be modified. 2) In the groups of NI and OB the interrelationship of factors such as alveolar hypoxia and pulmonary wedge pressure (PWP) play the major role in the genesis of PAH, although the role of the PaCO2 in the OB group remains to be established. 3) In the groups of NOC, CRI and TEP the PWP is not determinant. The absence of a significant correlation between arterial oxygen unsaturation and pulmonary diastolic pressure in the NOC group suggests other factors. 4) The vascular structural damage seems to be the most important factor in the genesis of PAH in the HAP-ED and CIV + HAP groups.
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PMID:[Active and passive factors in the genesis of pulmonary arterial hypertension in various cardiopathies and pneumopathies]. 678 61

One hundred ninety-one infants under 1 year of age underwent repair of coarctation of the aortz during a recent 14 year period. All operations were performed on an urgent, nonelective basis. One third of the infants had isolated coarctation (Group I), one third had associated ventricular septal defect (VSD) (Group II), and one third had other complex anomalies (Group III). The operative mortality rate has decreased to 4% in infants with isolated coarctation of the aorta but remains at 25% for repair of coarctation in association with significant intracardiac disease (Groups II and III). The late mortality rate also was affected by intracardiac defects. No late deaths occurred in Group I patients, whereas the 5 year mortality rate was 25% in Groups II and III. Surgical repair was by resection and end-to-end anastomosis in most (92%) cases. Recurrent coarctation, as defined by arm/leg blood pressure gradient at rest, developed in 54% of the survivors within 7 years following operation. Recoarctation did not affect late mortality rate. Twelve children (11.1% of survivors) underwent repair of recoarctation during this interval. Hypertension developed in 27% of the children followed more than 5 years after repair and was always associated with residual arm/leg blood pressure gradient. There are no cases of idiopathic hypertension in this series.
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PMID:Results of repair of coarctation of the aorta during infancy. 698 64

The experience we describe derives from the short-term administration of isoproterenol in 15 patients with ventricular septal defect (VSD) and severe pulmonary artery hypertension (PAH). For the whole study group, mean pulmonary artery pressure (PAP) was 68.5 +/- 2.6 mm Hg, pulmonary vascular resistance (Rp) was 11.6 +/- 0.9 U/m2, pulmonary vascular resistance/systemic vascular resistance ratio (Rp/Rs) was 0.9 +/- 0.03, and the pulmonary vascular gradient (PAd-PWP) was 45 +/- 3.5 mm Hg. Infusions of isoproterenol decreased PAP, Rp, Rp/Rs ratio, and PAd-PWP an average of 10.2 mm Hg, 2.88 U/m2, 0.13 and 6.6 mm Hg, respectively, for the whole group (P less than 0.001). On the basis of isoproterenol response, the patients could be divided into two groups: A (n = 4) and B (n = 11). In group A, the PAP decreased from 61.7 +/- 1 to 45 +/- 4 mm Hg, the Rp from 8.9 +/- 0.3 to 4.62 +/- 0.5 U/m2, the Rp/Rs from 0.84 +/- 0.02 to 0.55 +/- .05, and the PAd-PWP from 34.5 +/- 0.9 to 24 +/- 2 mm Hg (mean +/- 1 SE). In group B a less significant change in these measurements was observed. Group A patients underwent VSD repair, and the mean average postoperative decrease in PAP was 31 mm Hg (P less than 0.001). Our findings suggest that in patients with VSD and severe PAH, in whom surgical treatment is controversial, a trial with isoproterenol should be routinely attempted. If the preceding hemodynamic parameters improve significantly, the VSD repair should be performed.
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PMID:The role of isoproterenol in the preoperative evaluation of high-pressure, high-resistance ventricular septal defect. 705 41

Seven patients (one woman) have been seen with ascending aortic dissections at a mean of 8.8 years (6 months to 20 years) after cardiac operation. Previous cardiac operations included saphenous vein coronary artery bypass grafts (CAB) (two), aortic valve replacement (AVR) (one), aortic valvulotomy (one), AVR plus CAB (two), and patch closure of a ventricular septal defect and repair of a perforated aortic cusp (one). During the initial operation, three of seven patients had dilatation of the ascending aorta. Five of seven patients were hypertensive at the time of diagnosis of dissection. Six patients were managed by operation. A composite prosthetic aortic valve and ascending aortic graft with implantation of coronary ostia and saphenous vein grafts was utilized in three patients. In three the repair was by graft replacement of the ascending aorta alone. Five of six patients survived repair and were asymptomatic at discharge. Subsequent problems resulting from distal, descending thoracic, or abdominal aortic extension of the dissection were frequent and necessitated fenestration (one patient) or a graft replacement of the infrarenal aorta (one patient). We conclude that patients may be predisposed to aortic dissection occurring late after cardiac operation, possibly related to prior aortic valvular disease or systemic arterial hypertension. Operative repair is feasible and relatively safe. Follow-up for potential complications of distal aortic problems seems indicated. Techniques of operative repair in these patients are emphasized.
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PMID:Results of surgical treatment of ascending aortic dissections occurring late after cardiac operation. 706 67

Total correction of tetralogy of Fallot was performed on 161 consecutive patients between 1966 and 1979. Forty-four per cent had undergone a previous palliative operation. A right ventricular outflow patch was used in 58% of the patients. In about half of these cases, the patch extended across the pulmonary annulus onto the main pulmonary artery and in five per cent it extended beyond the pulmonary bifurcation. The overall operative mortality was 13%, for patients less than three years of age it was 38% and for patients three years and older 11%. Operative mortality was chiefly related to an unrelieved right ventricular hypertension. The use of an outflow patch did not influence the operative mortality. Eight survivors (6%) were re-operated upon, six due to residual outflow obstruction, one due to residual ventricular septal defect and in one patient re-operation was indicated because of neo-intimal thickening in a tubular dacron graft. Inadequate infundibulectomy (one patient), narrow pulmonary annulus (two patients), calcified valve remnants (two patients) and a ridge in the posterior wall of the main pulmonary artery (two patients, one of whom underwent two re-operations) were the anatomical bases for the obstructions. It is concluded that at total correction of tetralogy of Fallot every effort should be made to relieve the right ventricular outflow obstruction, even if the pulmonary valves have to be sacrificed. If the pulmonary artery is hypoplastic or has localized stenosis, the pulmonary annulus should be incised and an outflow patch carried all the way to the pulmonary artery branches.
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PMID:Reconstruction of the right ventricular outflow tract in patients with tetralogy of Fallot: early and late results. 707 45


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